PHP131 - WHAT USE IS DISTRIBUTED LEDGER TECHNOLOGY IN REAL-WORLD PRACTICE? - A SYSTEMATIC LITERATURE REVIEW

Abstract

Distributed ledger technology (DLT) – such as blockchain technology – allows the decentralized, irreversible transmission and management of data without the involvement of third parties. This offers data security and integrity, anonymity and transactional efficiency. We systematically reviewed the literature to identify current applications of this technology in healthcare and how it can impact real-world practice. EMBASE and PubMed were searched using words synonymous with “DLT” and “blockchain” for studies published in English from database inception to May 2018 and reporting on use of DLT in real-world clinical practice. Studies involving non-healthcare related fields or clinical trials were excluded. The electronic database searches yielded 1,466 unique abstracts, of which 76 were reviewed further as full-text publications and 27 relevant studies included. Nine described primary real-world healthcare research involving DLT while 18 reported potential uses of blockchain technology in generating real-world evidence. Primary research conducted in this area focused on data sharing through smartphone applications or through marketplaces where anonymized digital patient health records (PHRs) could be exchanged between patients and researchers for a monetary reward (cryptocurrency). Other potential DLT-based ideas identified from included studies were related to: 1) acceleration of biomedical research (drug/biomarker development) by creating decentralized personal health data repositories (from PHRs, wearable devices, pharmacies, and genetic data); 2) secure management and sharing of PHRs both during patient-to-physician communications and between physician and healthcare-providers without the use of intermediaries; 3) real-time tracking of pharmacy/insurance claims, and monitoring of healthcare data to improve care co-ordination and identification of emergency situations; and 4) simplification of healthcare financial transactions using cryptocurrencies. DLT has the potential to change radically how real-world data are generated, collected, and managed. More work is required to confirm that this state-of-the-art technology offers true efficiency benefits or if there are privacy concerns compared to traditional healthcare research methods.